Diastolic dysfunction is a feature of the antiphospholipid syndrome
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A M Hasnie1, M F Stoddard, C B Gleason
1Department of Medicine, University of Louisville, KY 40202, USA.
Insights
Primary antiphospholipid syndrome (PAPS) is linked to diastolic dysfunction, impacting left ventricular filling. This study reveals significant echocardiographic differences in PAPS patients compared to healthy controls, highlighting impaired cardiac function.
Area of Science:
- Cardiology
- Rheumatology
- Immunology
Background:
- Antiphospholipid syndrome (APS) is characterized by thrombosis and pregnancy complications, often associated with anticardiolipin antibodies.
- Cardiac involvement in primary APS (PAPS) typically involves structural and valvular heart disease.
- Diastolic dysfunction in PAPS remains under-described.
Purpose of the Study:
- To investigate the prevalence and characteristics of diastolic dysfunction in patients with primary antiphospholipid syndrome (PAPS).
- To compare left ventricular diastolic function between PAPS patients and healthy controls using echocardiography.
Main Methods:
- Echocardiographic assessment of 10 PAPS patients (mean age 30 +/- 7 years) and 10 age-, sex-, weight-, and height-matched healthy controls.
- Measurement of Doppler-derived left ventricular filling parameters, including peak early filling velocity, peak early to peak atrial filling velocity ratio, and deceleration rate.
- Enzyme-linked immunosorbent assay (ELISA) to confirm high anticardiolipin antibody concentrations (> 80 IgG phospholipid units) in PAPS patients.
Main Results:
- PAPS patients exhibited significantly impaired diastolic function compared to controls.
- Key findings include decreased peak early filling velocity (52 +/- 10 vs 67 +/- 12 cm/sec; p < 0.01) and a reduced early to atrial filling velocity ratio (1.03 +/- 0.40 vs 1.52 +/- 0.28; p < 0.005).
- Patients also showed a lower mean deceleration rate of early filling (338 +/- 75 vs 590 +/- 227 cm/sec2; p < 0.005) and increased atrial contribution to filling.
Conclusions:
- Diastolic dysfunction is a significant echocardiographic finding in patients with primary antiphospholipid syndrome.
- These diastolic abnormalities, particularly impaired left ventricular filling, are associated with high anticardiolipin antibody levels in PAPS.
- Further research is warranted to understand the clinical implications and management of diastolic dysfunction in PAPS.
Abstract:
Recurrent thrombi, thrombocytopenia, pregnancy loss, and stroke in association with medium to high concentrations of anticardiolipin antibodies are well-recognized features of antiphospholipid syndrome. Cardiac manifestations of primary antiphospholipid syndrome (PAPS) also have been documented but involve structural and valvular heart disease. Diastolic dysfunction in PAPS has not been well described. Therefore, 10 patients with PAPS (nine women and one man) of mean age 30 +/- 7 years (range 20 to 46 years) and 10 healthy age-, sex-, weight-, and height-matched control subjects were studied by echocardiography. Anticardiolipin antibody concentrations of patients with PAPS were > 80 immunoglobulin G phospholipid units as determined by enzyme-linked immunosorbent assay. Doppler-derived parameters of left ventricular filling showed a significant association between PAPS and diastolic dysfunction compared with control, as evidenced by a decrease in peak early filling velocity (52 +/- 10 cm/sec vs 67 +/- 12 cm/sec; p < 0.01), a decrease in the ratio of peak early to peak atrial filling velocities (1.03 +/- 0.40 vs 1.52 +/- 0.28; p < 0.005), a decrease in the mean deceleration rate of early filling (338 +/- 75 cm/sec2 vs 590 +/- 227 cm/sec2; p < 0.005), and an increase in the percentage of atrial contribution to filling and deceleration time. Left ventricular mass, diastolic filling time, and heart rate did not differ between groups. Left ventricular systolic function was normal and ejection fraction did not differ between patients with PAPS and control subjects (63% +/- 2% vs 65% +/- 7%; p not significant).(ABSTRACT TRUNCATED AT 250 WORDS)